Hi I was wondering what others think about using clinical simulation more in clinical supervision. I know we have role plays as part of TOTR and videos. I wondered whther incorporating videos into a session and then reviewing may be of help.

In my experience of clinical supervision of six students: 1 supervisor (me) in a musculoskeletal outpatient department (final year students in their 2nd last or last placement prior to graduation) I used simulation in the following ways during a 5-week student placement:

1. Each week, students acted as simulated patients for each other – they would get ‘up-to-speed’ with a particular patient history and then ‘act as the patient’. We would video-tape one aspect of the therapist-patient interaction e.g., taking a patient history, doing a physical examination, providing ‘hands on’ treatment or educating the patient. The student/actor’s role was to provide supportive challenge to their colleague either by their behaviour e.g., anger, distress, anxiety, use of questions, showing a lack of understanding and the student/therapist was expected to respond in professional/respectful/helpful ways. We would capture ~15-20 mins on video and the student/therapist was given this to review (what worked well? what issues/concerns came up for you? what do you need to work on? where would you like support?) and then they would meet with me (the supervisor) during a scheduled session (30-45 mins once/week to debrief).

Despite the fact it was a simulation…it is amazing how a camera on RECORD can increase ‘stress-levels’ to create a somewhat realistic situation in terms of putting a student ‘on-the-spot’. Students often picked up aspects of their behaviour that they were completely unaware of until they observed themselves and they all seemed to enjoy the process once they had done it once or twice. There was really positive feedback on the benefit to their learning & development.

2. Each student was expected to present a ‘case’ (one/week) involving one of the ‘difficult/challenging’ clients on their case list in a small tutorial to myself and their peers. After the presentation I would take on the role of that patient and the presenting student was then expected to demonstrate ‘hands on’ treatment techniques to their peers who could also have a go…on me as the patient. In some cases, the student may have had more questions than answers and so as a group we would ‘brainstorm’ and approach and then they had the opportunity to practice in a safe environment in preparation for when they would next see the patient. This helped them to gain consensus and confidence around particular management strategies and to practice in a safe/controlled environment.

Hi Jill, I personally have not had any experience with simulation , however the last student we had had completed a week simulated training before her placement with us(Community Health) and it was noted by myself and other staff that she was showing more confidence with patient interviews and clinical reasoning than previous students on the same placement.Margarets suggestion seems to work well with multiple students on placement.